1
|
Kokkinakis J, Schuett BS, Millar TJ. Effects on the Human Tear Film of Applying Skin Lipids to the Ocular Surface. Cornea 2023; 42:1562-1571. [PMID: 37506368 DOI: 10.1097/ico.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/05/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE The effect of skin lipids on the formation and stability of the human tear film was investigated. METHODS Skin swab substances (SSSs) were applied to the eyes of volunteers and studied using fluorescein or with TearView, which records infrared emissivity showing tear film integrity in real time. Results were compared with similar experiments using castor oil, freshly collected meibum, or acetic acid, which simulated the low pH of the skin. RESULTS Fluorescein and TearView results were comparable. TearView showed the natural unaltered tear film over the whole eye, instant changes to the tear film, and meibomian gland activity. Minimal amounts of SSS destroyed the integrity of the film and caused pain. Corneal epithelial damage could be detected. TearView showed that SSS stimulated meibomian gland secretion if applied directly to the posterior eyelid margin. Excess meibum had no effect on the tear film spread or integrity. Castor oil formed floating lenses on the tear film which were spread by a blink but then condensed back toward themselves. There was no pain or surface damage with these oils. CONCLUSIONS SSS contamination of the ocular surface disrupts the tear film, causes stinging, and fluorescein staining of the corneal epithelial cells after a blink. SSS stimulates meibomian gland activity. It is possible that various ocular conditions associated with dry eye, such as blepharitis and ocular rosacea, may compromise a meibomian lipid barrier of the eye lid margin. Skin lipids would then have access to the ocular surface and cause dry eye symptoms.
Collapse
Affiliation(s)
- Jim Kokkinakis
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
- The Eye Practice, Sydney, NSW, Australia; and
| | | | | |
Collapse
|
2
|
Is contact lens discomfort related to meibomian gland morphology? Cont Lens Anterior Eye 2022; 45:101743. [PMID: 36028427 DOI: 10.1016/j.clae.2022.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the relationship between contact lens (CL) discomfort and meibomian gland (MG) morphology assessed by a semi-objective software in subjects without an alteration of MG function (meibum quality and expressibility). METHODS Nineteen symptomatic (CLDEQ-8 ≥ 12) CL wearers, 19 asymptomatic (CLDEQ-8 < 12) wearers, and 22 non-wearers were recruited. Upper and lower eyelid meibography images were taken and the following parameters were analysed using a semi-objective software in the central 2/3 of each eyelid: number of MG, number of partial MG, percentage of MG loss and percentage of tortuosity. One-way ANOVA or Kruskal-Wallis H test were used for comparisons among groups. The relationships between CLDEQ-8 and MG morphology parameters were analysed using the Spearman correlation coefficient and multivariable linear regression models. RESULTS No significant differences were found among groups in the MG morphology of the upper or lower eyelids. In all CL wearers, a significant correlation with CLDEQ-8 was found in the upper eyelid for the number of MG (rho = 0.47, p = 0.003). In symptomatic wearers, significant correlations with CLDEQ-8 were found in the lower eyelid for the number of partial MG (rho = 0.49, p = 0.03) and the percentage of partial MG (rho = 0.61, p = 0.005). In all CL wearers, multivariable models were fitted to explain CLDEQ-8 score including the number of MG, the number of partial MG and the percentage of MG loss from the lower eyelid (R2 = 0.19; p = 0.007), and the number of MG from the upper eyelid (R2 = 0.19; p = 0.001). In symptomatic wearers, a model was fitted including the percentage of MG loss from the lower eyelid (R2 = 0.30; p = 0.016). CONCLUSIONS Alterations of MG morphology, without clinically apparent alteration of MG function, can be involved in causing CL discomfort and influence the degree of symptoms. The differences in findings between eyelids indicate the need to monitor both eyelids, especially the lower one, in CL wearers.
Collapse
|
3
|
Ewurum A, Veligandla SR, Swindle JS, Clark JD, Borchman D. A spectroscopic approach to measuring meibum lipid composition and conformation in donors with Sjӧgren's syndrome. Exp Eye Res 2021; 210:108713. [PMID: 34363797 PMCID: PMC8429180 DOI: 10.1016/j.exer.2021.108713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 07/29/2021] [Indexed: 01/15/2023]
Abstract
Patients with Sjӧgren's syndrome (SS) have dry eye associated with meibomian gland dysfunction (MGD). The meibum from donors with dry eye due to MGD but without SS (MMGD) presents with lower levels of cholesteryl ester, less straight chains, and more ordered hydrocarbon chains compared with meibum from donors without MGD (Mn). The aim of the current study was to compare the composition and hydrocarbon chain conformation of meibum from donors with Sjögren's syndrome (Mss) to Mn and MMGD. Meibum was expressed from patients with SS using an ILUX instrument (Alcon Inc., Fort Worth TX). All of the nine meibum donors with SS were female. Meibum composition was characterized using 1H-NMR and meibum hydrocarbon chain conformation was measured using fourier transform infrared spectroscopy. Meibum from every donor with SS measured contained a significantly (P < 0.01) higher cholesteryl ester/wax ester ratio and more straight chains compared with donors without SS or dry eye. None of the nine phase transitional parameters were significantly different, P > 0.05, for Mss compared with Mn. Nor was the CH3/CH2 band height ratio used to estimate the number of hydrocarbon CH3 and CH2 moieties different, P = 0.22, for Mss compared with Mn. In conclusion, the compositional differences between Mss compared with Mn did not result in differences in any of the nine meibum lipid phase transitional parameters measured. The compositional differences observed between Mss and Mn could be markers for or contribute to SS as the differences could lead to tear film lipid packing differences other than conformational differences.
Collapse
Affiliation(s)
- Anthony Ewurum
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Sravya R Veligandla
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Jordan S Swindle
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Jeremy D Clark
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA
| | - Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA.
| |
Collapse
|
4
|
Borchman D. Lipid conformational order and the etiology of cataract and dry eye. J Lipid Res 2021; 62:100039. [PMID: 32554545 PMCID: PMC7910524 DOI: 10.1194/jlr.tr120000874] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Lens and tear film lipids are as unique as the systems they reside in. The major lipid of the human lens is dihydrosphingomylein, found in quantity only in the lens. The lens contains a cholesterol to phospholipid molar ratio as high as 10:1, more than anywhere else in the body. Lens lipids contribute to maintaining lens clarity, and alterations in lens lipid composition due to age are likely to contribute to cataract. Lens lipid composition reflects adaptations to the unique characteristics of the lens: no turnover of lens lipids or proteins; the lowest amount of oxygen of any tissue; and contains almost no intracellular organelles. The tear film lipid layer (TFLL) is also unique. The TFLL is a thin (100 nm) layer of lipid on the surface of tears covering the cornea that contributes to tear film stability. The major lipids of the TFLL are wax esters and cholesterol esters that are not found in the lens. The hydrocarbon chains associated with the esters are longer than those found anywhere else in the body (as long as 32 carbons), and many are branched. Changes in the composition and structure of the 30,000 different moieties of TFLL contribute to the instability of tears. The focus of the current review is how spectroscopy has been used to elucidate the relationships between lipid composition, conformational order and function, and the etiology of cataract and dry eye.
Collapse
Affiliation(s)
- Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY 40202.
| |
Collapse
|
5
|
Widjaja-Adhi MAK, Silvaroli JA, Chelstowska S, Trischman T, Bederman I, Sayegh R, Golczak M. Deficiency in Acyl-CoA:Wax Alcohol Acyltransferase 2 causes evaporative dry eye disease by abolishing biosynthesis of wax esters. FASEB J 2020; 34:13792-13808. [PMID: 32851726 PMCID: PMC7722226 DOI: 10.1096/fj.202001191r] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
Lipids secreted by the meibomian glands (MGs) of the eyelids are essential to the protection of the eye's surface. An altered meibum composition represents the primary cause of evaporative dry eye disease (DED). Despite the critical importance of the meibum, its biosynthetic pathways and the roles of individual lipid components remain understudied. Here, we report that the genetic deletion of Acyl-CoA:wax alcohol acyltransferase 2 (AWAT2) causes the obstruction of MGs and symptoms of evaporative DED in mice. The lipid composition of the meibum isolated from Awat2-/- mice revealed the absence of wax esters, which was accompanied by a compensatory overproduction of cholesteryl esters. The resulting increased viscosity of meibum led to the dilation of the meibomian ducts, and the progressive degeneration of the MGs. Overall, we provide evidence for the main physiological role of AWAT2 and establish Awat2-/- mice as a model for DED syndrome that can be used in studies on tear film-oriented therapies.
Collapse
Affiliation(s)
| | - Josie A. Silvaroli
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sylwia Chelstowska
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas Trischman
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ilya Bederman
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rony Sayegh
- Department of Ophthalmology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Marcin Golczak
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA,Cleveland Center for Membrane and Structural Biology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
6
|
Kuo YK, Lin IC, Chien LN, Lin TY, How YT, Chen KH, Dusting GJ, Tseng CL. Dry Eye Disease: A Review of Epidemiology in Taiwan, and its Clinical Treatment and Merits. J Clin Med 2019; 8:E1227. [PMID: 31443274 PMCID: PMC6722537 DOI: 10.3390/jcm8081227] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022] Open
Abstract
Dry eye disease (DED) has become common on a global scale in recent years. There is a wide prevalence of DED in different countries based on various ethnicities and environment. DED is a multifactorial ocular disorder. In addition to advanced age and gender, such factors as living at high altitude, smoking, pterygium, prolonged use of consumer electronics or overingesting of caffeine or multivitamins are considered to be the major risk factors of DED. We report the DED epidemiology in Taiwan firstly in this article. According to the pathophysiological factors and changes inthe composition of the tear film in DED, it can be categorized into several subtypes, including lipid anomaly dry eye, aqueous tear deficiency, allergic and toxic dry eye among others. Each subtype has its own cause and disease management; therefore, it is important for ophthalmologists to identify the type through literature review and investigation. The management of DED, relies not only on traditional medications such as artificial tears, gels and ointments, but also newer treatment options such as acupuncture, SYL1001, and nanomedicine therapy. We also conducted a comprehensive literature review including common subtypes and treatment of DED. Clearly, more clinical trials are needed to assess the efficacy and safety of the various treatments and common subtypes of DED.
Collapse
Affiliation(s)
- Yu-Kai Kuo
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Chan Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, , Taipei Medical University, Taipei 11031, Taiwan
- Health and Clinical Data Research Center, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Tzu-Yu Lin
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ying-Ting How
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
| | - Ko-Hua Chen
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Gregory J Dusting
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - Ching-Li Tseng
- Graduate Institute of Biomedical Materials & Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Institute of International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- Research Center of Biomedical Device, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
- International PhD Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| |
Collapse
|
7
|
Lipid Saturation and the Rheology of Human Tear Lipids. Int J Mol Sci 2019; 20:ijms20143431. [PMID: 31336861 PMCID: PMC6678947 DOI: 10.3390/ijms20143431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 02/03/2023] Open
Abstract
Elevated levels of acyl chain saturation of meibomian lipids are associated with enhanced tear film (TF) stability in infants to shortened TF breakup time with meibomian gland dysfunction. Thus, the effect of saturation on the surface properties of human TF lipids (TFLs) using a Langmuir surface balance and Brewster angle microscopy was studied. Lipid phase transitions were measured using infrared spectroscopy. The raise in the % of saturation resulted in thicker, and more elastic films at π = 12 mN/m, with the effects being proportional to the saturation level. At the same time, at lower (≤10 mN/m) π, the raise in saturation resulted in an altered spreading and modified structure of TFL layers. The strong impact of saturation on TFL surface properties correlated with a saturation induced increase of the TFL acyl chain order, phase transition temperature, and lipid-lipid interactions. The native TFL order and πmax were significantly greater, compared with native meibum collected from the same individual. Aggregation of lipids on the tear surface due to saturation was not as significant as it was for meibum. Although the surface pressure/area isotherms for TFL were similar for meibum, differences in rheology and phase transition parameters warrant the study of both.
Collapse
|
8
|
Badawi D. TearCare ® system extension study: evaluation of the safety, effectiveness, and durability through 12 months of a second TearCare ® treatment on subjects with dry eye disease. Clin Ophthalmol 2019; 13:189-198. [PMID: 30774298 PMCID: PMC6348966 DOI: 10.2147/opth.s191588] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose Evaluation of the safety and effectiveness of a TearCare® retreatment in adult subjects with clinically significant dry eye disease (DED). Patients and methods This was an extension of an initial 6-month, prospective, single-center, randomized, parallel-group pilot study. In the initial study, subjects with DED were randomized to either a single TearCare® treatment or 4 weeks of daily warm compress therapy. The extension study involved retreatment of those subjects assigned to the TearCare® treatment group following the initial 6-month end point. At 6 months, subjects were evaluated for the clinical signs and symptoms of DED prior to retreatment in the extension study that would measure the safety, effectiveness, and durability of a TearCare® retreatment for another 6 months through a 12-month end point. The TearCare® retreatment procedure consisted of 12 minutes of thermal eyelid treatment immediately followed by manual meibomian gland clearance. The primary effectiveness end point was the change in tear break-up time (TBUT) from baseline to 1-month follow-up. Secondary end points included meibomian gland scores, corneal and conjunctival staining scores, and assessment of dry eye symptoms. Safety was evaluated through monitoring intraocular pressure, best-corrected visual acuity, and device-related adverse events. Results Twelve subjects participated in the 6-month extension study. At 1-month clinic visit following retreatment, a significant improvement from baseline in mean (± SD) TBUT of 12.4 (±3.3) seconds was observed (P<0.001). Significant improvements in the mean change from baseline in meibomian gland scores, corneal and conjunctival staining scores, and symptoms of DED were also observed following retreatment. The second treatment was well tolerated. Conclusion The findings of the extension study through 12 months suggest that a second TearCare® treatment after 6 months provides additional improvement in the signs and symptoms of DED.
Collapse
Affiliation(s)
- David Badawi
- Clinical Trials Section, Central Eye Care, Arlington Heights, IL, USA,
| |
Collapse
|
9
|
Rabensteiner DF, Aminfar H, Boldin I, Schwantzer G, Horwath‐Winter J. The prevalence of meibomian gland dysfunction, tear film and ocular surface parameters in an Austrian dry eye clinic population. Acta Ophthalmol 2018; 96:e707-e711. [PMID: 29656524 PMCID: PMC6619403 DOI: 10.1111/aos.13732] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/21/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to assess the prevalence of meibomian gland dysfunction (MGD) and its association with tear film and ocular surface parameters in an Austrian clinical population of dry eye patients. METHODS The records of 1372 consecutive patients from a dry eye unit were analysed retrospectively. Symptoms and objective tear film and ocular surface parameters were evaluated. Patients were classified into pure MGD, pure aqueous tear deficiency (ATD), MGD combined with ATD, pure anterior blepharitis (AB), Sjogren's syndrome (SS) without MGD and SS together with MGD. RESULTS Nine-hundred and sixty-five patients, that is 70.3% of the investigated population, mean age 55.4 ± 16.6 years, had signs of MGD. Of these, 684 (70.9%) were female. The intensity of symptoms did not differ between subgroups. Four hundred and ninety (50.8%) MGD patients had Schirmer test values ≤10 mm/5 min. The fluorescein break-up time and Schirmer test values were significantly higher in the pure AB and MGD group. The pure MGD group showed a significantly lower fluorescein staining of the cornea compared to the other groups, except for pure AB. Lissamine green staining of the ocular surface was present in all groups, but was at least pronounced in the pure MGD and AB group. CONCLUSION Meibomian gland dysfunction is a major cause of ocular discomfort and could often be found in combination with a reduced aqueous tear secretion. Although the intensity of subjective complaints was similar to all other subgroups, pure MGD exhibited the lowest severity of signs of ocular surface damage and also affected younger people.
Collapse
Affiliation(s)
| | - Haleh Aminfar
- Department of OphthalmologyMedical University of GrazGrazAustria
| | - Ingrid Boldin
- Department of OphthalmologyMedical University of GrazGrazAustria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation of the Medical University of GrazGrazAustria
| | | |
Collapse
|
10
|
Zhong S, Zhou H, Chen X, Zhang W, Yi L. Influence of glaucoma surgery on the ocular surface using oculus keratograph. Int Ophthalmol 2018; 39:745-752. [PMID: 29691696 DOI: 10.1007/s10792-018-0869-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/15/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the influence of trabeculectomy and phacotrabeculectomy on the ocular surface. DESIGN Retrospective, case-control study. METHODS Eighty-one samples without dry eyes were recruited and divided into three groups, including phacoemulsification group (N = 30) as control group, trabeculectomy group (N = 27) and phacotrabeculectomy group (N = 24) as study groups. Ocular surface parameters, including noninvasive keratograph first (NifBUT) and average (NiaBUT) tear film breakup time, tear meniscus height (TMH) and corneal fluorescein stain (CFS), were estimated preoperatively, at 3 days, 1 month and 3 months postoperatively using oculus keratograph. RESULTS No significant difference was observed in ocular surface parameters at baseline among three groups (p > 0.05). The magnitude of NifBUT and NiaBUT was reduced at 3 days and 1 month postoperatively in phacotrabeculectomy group, but greater than that in the other two groups (All p < 0.001). In all the groups, both the NifBUT and NiaBUT tended to recover at 1 and 3 months postoperatively, whereas both of them did not recover to baseline at 3 months postoperatively in trabeculectomy (NifBUT, p = 0.001; NiaBUT, p < 0.001) and phacotrabeculectomy group (NifBUT, p < 0.001; NiaBUT, p = 0.020). TMH was raised at 3 days postoperatively and restored to the baseline level at 1 and 3 months postoperatively for three groups (p > 0.05). CFS was elevated at 3 days postoperatively and different in recovery at 1 and 3 months postoperatively for three groups. CONCLUSIONS The influence of phacotrabeculectomy on ocular surface is worse than that of trabeculectomy for the short run and is not distinct different for a long time.
Collapse
Affiliation(s)
- Sue Zhong
- Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Ophthalmology, Wuhan General Hospital of the People's Liberation Army, 627 S. Wu Luo Road, Wuhan, 430070, Hubei, China.,Department of Ophthalmology, The Second People's Hospital of Three Gorges University, Yichang, 443000, Hubei, China
| | - Hezheng Zhou
- Southern Medical University, Guangzhou, 510515, Guangdong, China. .,Department of Ophthalmology, Wuhan General Hospital of the People's Liberation Army, 627 S. Wu Luo Road, Wuhan, 430070, Hubei, China.
| | - Xiao Chen
- Department of Ophthalmology, Wuhan General Hospital of the People's Liberation Army, 627 S. Wu Luo Road, Wuhan, 430070, Hubei, China
| | - Wenqiang Zhang
- Department of Ophthalmology, Wuhan General Hospital of the People's Liberation Army, 627 S. Wu Luo Road, Wuhan, 430070, Hubei, China
| | - Liqun Yi
- Department of Ophthalmology, The Second People's Hospital of Three Gorges University, Yichang, 443000, Hubei, China
| |
Collapse
|
11
|
Badawi D. A novel system, TearCare ®, for the treatment of the signs and symptoms of dry eye disease. Clin Ophthalmol 2018; 12:683-694. [PMID: 29692600 PMCID: PMC5903489 DOI: 10.2147/opth.s160403] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The objective of this study was to evaluate the safety and effectiveness of the TearCare® System in adult patients with clinically significant dry eye disease (DED). PATIENTS AND METHODS This was a prospective, single-center, randomized, parallel-group, clinical trial. Subjects with DED were randomized to either a single TearCare treatment conducted at the clinic or 4 weeks of daily warm compress (WC) therapy. The TearCare procedure consisted of 12 minutes of thermal eyelid treatment immediately followed by manual expression of the meibomian glands. WC therapy consisted of once daily application of the compresses to the eyelids for 5 minutes. Subjects were followed until 6 months post-treatment. The primary effectiveness end point was defined as change from baseline to 4 weeks for tear breakup time (TBUT). Secondary effectiveness end points included meibomian gland assessment, corneal and conjunctival staining scores, and assessment of dry eye symptoms using validated questionnaires. Safety was evaluated by collecting device-related adverse events, intraocular pressure, and best spectacle-corrected Snellen Visual acuity. RESULTS Twenty-four subjects were enrolled and all subjects completed 6 months follow-up. At the 1-month follow-up, TearCare subjects demonstrated an improvement from baseline in mean (±SD) TBUT of 11.7±2.6 seconds compared with an average worsening of -0.3±1.1 seconds for subjects in the WC group (p<0.0001). Significantly greater improvements in the change from baseline in meibomian gland scores, as well as corneal and conjunctival staining scores, were observed in the TearCare group. Subjects in the TearCare group also showed significantly greater improvement in dry eye symptoms as measured by the 3 questionnaires. Both treatments were well-tolerated. CONCLUSION The findings of this pilot study suggest that the TearCare System is an effective treatment option for patients with DED, with the effects on the signs and symptoms of DED persisting for at least 6 months.
Collapse
Affiliation(s)
- David Badawi
- Clinical Trials Section, Central Eye Care, Arlington Heights, IL, USA
| |
Collapse
|
12
|
Kim S, Yoo YS, Kim HS, Joo CK, Na KS. Changes of meibomian glands in the early stage of post hematopoietic stem cell transplantation. Exp Eye Res 2017; 163:85-90. [PMID: 28739099 DOI: 10.1016/j.exer.2017.07.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/29/2017] [Accepted: 07/20/2017] [Indexed: 01/24/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the most effective cure for hematologic malignancies. Graft-versus-host disease (GVHD) is a major complication following allogeneic HSCT, which significantly affects non-relapse mortality. And ocular manifestations of GVHD are known to occurin 60-90% of patients with chronic GVHD. Although the pathogenesis of ocular GVHD is not clearly known, it is known to progress into inflammation and fibrosis through presentation of antigens on CD4 and CD8 T cells. There is much evidence that the ocular surface and meibomian glands are severely damaged in ocular GVHD patients, and there are few observational studies on the early changes. In this review, we will discuss the various changes in the meibomian glands and ocular surface, and tear dynamics in the early stage following HSCT. These results show that tear film break-up time (TFBUT) decreased and the corneal staining score was significantly higher 2-3 months after HSCT. The upper eyelid and total eyelid meiboscore increased after 3 months following HSCT. The information of the early changes of meibomian glands morphology would be helpful to further examine the pathogenesis of meibomian gland dysfunction.
Collapse
Affiliation(s)
- Seonjoo Kim
- Department of Ophthalmology & Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Sik Yoo
- Department of Convergence Medical Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Seung Kim
- Department of Ophthalmology & Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Choun-Ki Joo
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kyung-Sun Na
- Department of Ophthalmology & Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|
13
|
TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15:539-574. [DOI: 10.1016/j.jtos.2017.05.001] [Citation(s) in RCA: 836] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
|
14
|
Mudgil P, Borchman D, Gerlach D, Yappert MC. Sebum/Meibum Surface Film Interactions and Phase Transitional Differences. Invest Ophthalmol Vis Sci 2017; 57:2401-11. [PMID: 27145473 PMCID: PMC5113983 DOI: 10.1167/iovs.16-19117] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Sebum may contribute to the composition of the tear film lipid layer naturally or as a contaminant artifact from collection. The aims of this study were to determine: if sebum changes the rheology of meibum surface films; if the resonance near 5.2 ppm in the 1H-NMR spectra of sebum is due to squalene (SQ); and if sebum or SQ, a major component of sebum, interacts with human meibum. Methods Human meibum was collected from the lid margin with a platinum spatula. Human sebum was collected using lipid absorbent tape. Langmuir trough technology was used to measure the rheology of surface films. Infrared spectroscopy was used to measure lipid conformation and phase transitions. We used 1H-NMR to measure composition and confirm the primary structure of SQ. Results The NMR resonance near 5.2 ppm in the spectra of human sebum was from SQ which composed 28 mole percent of sebum. Both sebum and SQ lowered the lipid order of meibum. Sebum expanded meibum films at lower concentrations and condensed meibum films at higher concentrations. Sebum caused meibum to be more stable at higher pressures (greater maximum surface pressure). Conclusions Physiological levels of sebum would be expected to expand or fluidize meibum making it spread better and be more surface active (qualities beneficial for tear film stability). Sebum would also be expected to stabilize the tear film lipid layer, which may allow it to withstand the high shear pressure of a blink.
Collapse
Affiliation(s)
- Poonam Mudgil
- School of Medicine Western Sydney University, Penrith, New South Wales, Australia
| | - Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States
| | - Dylan Gerlach
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, Kentucky, United States
| | - Marta C Yappert
- Department of Chemistry, University of Louisville, Louisville, Kentucky, United States
| |
Collapse
|
15
|
Kaido M, Ibrahim OMA, Kawashima M, Ishida R, Sato EA, Tsubota K. Eyelid cleansing with ointment for obstructive meibomian gland dysfunction. Jpn J Ophthalmol 2016; 61:124-130. [DOI: 10.1007/s10384-016-0477-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
|
16
|
Butovich IA, McMahon A, Wojtowicz JC, Lin F, Mancini R, Itani K. Dissecting lipid metabolism in meibomian glands of humans and mice: An integrative study reveals a network of metabolic reactions not duplicated in other tissues. Biochim Biophys Acta Mol Cell Biol Lipids 2016; 1861:538-53. [PMID: 27032494 DOI: 10.1016/j.bbalip.2016.03.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022]
Abstract
Lipids comprise the bulk of the meibomian gland secretion (meibum) which is produced by meibocytes. Complex arrays of lipogenic reactions in meibomian glands, which we collectively call meibogenesis, have not been explored on a molecular level yet. Our goals were to elucidate the possible biosynthetic pathways that underlie the generation of meibum, reveal similarities in, and differences between, lipid metabolism in meibomian glands and other organs and tissues, and integrate meibomian gland studies into the field of general metabolomics. Specifically, we have conducted detailed analyses of human and mouse specimens using genomic, immunohistochemical, and lipidomic approaches. Among equally highly expressed genes found in meibomian glands of both species were those related to fatty acid elongation, branching, desaturation, esterification, reduction of fatty acids to alcohols, and cholesterol biosynthesis. Importantly, corresponding lipid products were detected in meibum of both species using lipidomic approaches. For the first time, a cohesive, unifying biosynthetic scheme that connects genomic, lipidomic, and immunohistochemical observations is outlined and discussed.
Collapse
Affiliation(s)
- Igor A Butovich
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; The Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Anne McMahon
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Jadwiga C Wojtowicz
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Feng Lin
- Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Ronald Mancini
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kamel Itani
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| |
Collapse
|
17
|
Surface Properties of Squalene/Meibum Films and NMR Confirmation of Squalene in Tears. Int J Mol Sci 2015; 16:21813-31. [PMID: 26370992 PMCID: PMC4613282 DOI: 10.3390/ijms160921813] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 12/16/2022] Open
Abstract
Squalene (SQ) possesses a wide range of pharmacological activities (antioxidant, drug carrier, detoxifier, hydrating, emollient) that can be of benefit to the ocular surface. It can come in contact with human meibum (hMGS; the most abundant component of the tear film lipid layer) as an endogenous tear lipid or from exogenous sources as eyelid sebum or pharmaceuticals. The aims of this study were to determine (i) if SQ is in tear lipids and (ii) its influence on the surface properties of hMGS films. Heteronuclear single quantum correlation NMR confirmed 7 mol % SQ in Schirmer’s strips extracts. The properties of SQ/hMGS pseudo-binary films at the air/water interface were studied with Langmuir surface balance, stress-relaxation dilatational rheology and Brewster angle microscopy. SQ does not possess surfactant properties. When mixed with hMGS squalene (i) localized over the layers’ thinner regions and (ii) did not affect the film pressure at high compression. Therefore, tear SQ is unlikely to instigate dry eye, and SQ can be used as a safe and “inert” ingredient in formulations to protect against dry eye. The layering of SQ over the thinner film regions in addition to its pharmacological properties could contribute to the protection of the ocular surface.
Collapse
|
18
|
Die Häufigkeit der Meibom-Drüsen-Dysfunktion bei PatientInnen mit Beschwerden des Trockenen Auges in einer klinischen Population. SPEKTRUM DER AUGENHEILKUNDE 2013. [DOI: 10.1007/s00717-013-0197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
19
|
[Testosterone reduces the expression of keratinization-promoting genes in murine Meibomian glands]. Ophthalmologe 2013; 110:230-8. [PMID: 23224122 DOI: 10.1007/s00347-012-2661-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Extensive keratinization appears to play a major role in the dysfunction of the Meibomian gland. This article presents the potential impact of androgens on limiting keratinization in this tissue, thus, contributing to normal Meibomian gland function and a healthy ocular surface. MATERIALS AND METHODS Orchidectomized mice were systemically treated with either testosterone or placebo for 2 weeks. The mRNA was then extracted from the Meibomian glands and differential gene expression was investigated by microarray hybridization and evaluation with GeneSifter software as well as gene ontology information from the Gene Ontology (GO) Consortium. RESULTS By z-score calculations, keratinization was the most significantly gene ontology term influenced by testosterone based on down-regulated genes in the mouse Meibomian gland. In particular, under the influence of testosterone the genes coding for small proline-rich protein (Sprr) 2a, Sprr 2b, Sprr 3, keratins 6a and 17 and periplakin were significantly down-regulated, while Sprr 1a and Sprr 2f were significantly up-regulated. CONCLUSIONS Testosterone down-regulates the expression of genes promoting keratinization in the Meibomian gland. This may help to prevent Meibomian gland dysfunction by limiting excessive keratinization of this tissue and the adjacent lid margins. The findings elucidate, at least in part, the beneficial impact of androgens on Meibomian gland function and thus on th e health of the ocular surface.
Collapse
|
20
|
|
21
|
Evidence Suggesting That the Keratinized Portions of the Upper and Lower Lid Margins Do Not Make Complete Contact During Deliberate Blinking. Cornea 2013; 32:491-5. [DOI: 10.1097/ico.0b013e31826a1e6f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Li L, Jin D, Gao J, Wang L, Liu X, Wang J, Xu Z. Activities of autonomic neurotransmitters in Meibomian gland tissues are associated with menopausal dry eye. Neural Regen Res 2012; 7:2761-9. [PMID: 25317125 PMCID: PMC4190857 DOI: 10.3969/j.issn.1673-5374.2012.35.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 10/11/2012] [Indexed: 11/18/2022] Open
Abstract
The secretory activities of meibomian glands are regulated by the autonomic nervous system. The change in density and activity of autonomic nerves in meibomian glands during menopause play an important role in the pathogenesis of dry eye. In view of this, we established a dry eye rat model by removing the bilateral ovaries. We used neuropeptide Y and vasoactive intestinal polypeptide as markers of autonomic neurotransmitters. Our results showed that the concentration of estradiol in serum significantly decreased, the density of neuropeptide Y immunoreactivity in nerve fibers significantly increased, the density of vasoactive intestinal polypeptide immunoreactivity in nerve fibers significantly decreased, and the ratio of vasoactive intestinal polypeptide/neuropeptide Y positive staining significantly decreased. These results suggest that a decrease in ovary activity may lead to autonomic nervous system dysfunction, thereby affecting the secretory activity of the meibomian gland, which participates in sexual hormone imbalance-induced dry eye.
Collapse
Affiliation(s)
- Lianxiang Li
- Department of Anatomy, Histology and Embryology, Laboratory of Basic Medicine, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Dongling Jin
- Department of Pathology, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Jinsheng Gao
- Department of Pathology, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Liguang Wang
- Department of Physiology, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Xianjun Liu
- Department of Pathology, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Jingzhang Wang
- Department of Biochemistry, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| | - Zhongxin Xu
- Department of Anatomy, Histology and Embryology, Laboratory of Basic Medicine, Medical College, Hebei University of Engineering, Handan 056002, Hebei Province, China
| |
Collapse
|
23
|
|
24
|
Butovich IA, Arciniega JC, Lu H, Molai M. Evaluation and quantitation of intact wax esters of human meibum by gas-liquid chromatography-ion trap mass spectrometry. Invest Ophthalmol Vis Sci 2012; 53:3766-81. [PMID: 22531701 DOI: 10.1167/iovs.11-9333] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Wax esters (WE) of human meibum are one of the largest group of meibomian lipids. Their complete characterization on the level of individual intact lipid species has not been completed yet. We obtained detailed structural information on previously uncharacterized meibomian WE. METHODS Intact WE were separated and analyzed by means of high-temperature capillary gas-liquid chromatography (GLC) in combination with low voltage (30 eV) electron ionization ion trap mass spectrometry (ITMS). 3D (mass-to-charge ratio [m/z] versus lipid sample weight versus signal intensity) calibration plots were used for quantitation of WE. RESULTS We demonstrated that GLC-ITMS was suitable for analyzing unpooled/underivatized WE collected from 14 individual donors. More than 100 of saturated and unsaturated WE (SWE and UWE, respectively) were detected. On average, UWE represented about 82% of the total WE pool. About 90% of UWE were based on oleic acid, while less than 10% were based on palmitoleic acid. The amounts of poly-UWE were <3% of their mono-UWA counterparts. SWE were based primarily on C(16)-C(18) fatty acids (FA) in overall molar ratios of 22:65:13. A pool of C(16:0)-FA was comprised of a 20:80 (mol/mol) mixture of straight chain and iso-branched isomers, while the corresponding ratio for C(18:0)-FA was 43:57. Interestingly, C(17:0)-FA was almost exclusively branched, with anteiso- and iso-isomers found in a ratio of 93:7. CONCLUSIONS GLC-ITMS can be used successfully to analyze more than 100 individual species of meibomian WE, which were shown to comprise 41 ± 8% (wt/wt) of meibum, which made them the largest group of lipids in meibum.
Collapse
Affiliation(s)
- Igor A Butovich
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA.
| | | | | | | |
Collapse
|
25
|
King-Smith PE, Nichols JJ, Braun RJ, Nichols KK. High resolution microscopy of the lipid layer of the tear film. Ocul Surf 2012; 9:197-211. [PMID: 22023815 DOI: 10.1016/s1542-0124(11)70033-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tear film evaporation is controlled by the lipid layer and is an important factor in dry eye conditions. Because the barrier to evaporation depends on the structure of the lipid layer, a high resolution microscope has been constructed to study the lipid layer in dry and in normal eyes. The microscope incorporates the following features. First, a long working distance microscope objective is used with a high numerical aperture and resolution. Second, because such a high resolution objective has limited depth of focus, 2000 images are recorded with a video camera over a 20-sec period, with the expectation that some images will be in focus. Third, illumination is from a stroboscopic light source having a brief flash duration, to avoid blurring from movement of the lipid layer. Fourth, the image is in focus when the edge of the image is sharp - this feature is used to select images in good focus. Fifth, an aid is included to help align the cornea at normal incidence to the axis of the objective so that the whole lipid image can be in focus. High resolution microscopy has the potential to elucidate several characteristics of the normal and abnormal lipid layer, including different objects and backgrounds, changes in the blink cycle, stability and fluidity, dewetting, gel-like properties and possible relation to lipid domains. It is expected that high resolution microscopy of the lipid layer will provide information about the mechanisms of dry eye disorders. Illustrative results are presented, derived from over 10,000 images from 375 subjects.
Collapse
Affiliation(s)
- P Ewen King-Smith
- College of Optometry, Ohio State University, Columbus, Ohio 43210, USA.
| | | | | | | |
Collapse
|
26
|
Liu S, Richards SM, Lo K, Hatton M, Fay A, Sullivan DA. Changes in gene expression in human meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2011; 52:2727-40. [PMID: 21372006 PMCID: PMC3088560 DOI: 10.1167/iovs.10-6482] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/15/2010] [Accepted: 03/01/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Meibomian gland dysfunction (MGD) may be the leading cause of dry eye syndrome throughout the world. However, the precise mechanism(s) underlying the pathogenesis of this disease is unclear. This study was conducted to identify meibomian gland genes that may promote the development and/or progression of human MGD. METHODS Lid tissues were obtained from male and female MGD patients and age-matched controls after eyelid surgeries (e.g., to correct entropion or ectropion). Meibomian glands were isolated and processed for RNA extraction and the analysis of gene expression. RESULTS The results show that MGD is associated with significant alterations in the expression of almost 400 genes in the human meibomian gland. The levels of 197 transcripts, including those encoding various small proline-rich proteins and S100 calcium-binding proteins, are significantly increased, whereas the expression of 194 genes, such as claudin 3 and cell adhesion molecule 1, is significantly decreased. These changes, which cannot be accounted for by sex differences, are accompanied by alterations in many gene ontologies (e.g., keratinization, cell cycle, and DNA repair). The findings also show that the human meibomian gland contains several highly expressed genes that are distinct from those in an adjacent tissue (i.e., conjunctival epithelium). CONCLUSIONS The results demonstrate that MGD is accompanied by multiple changes in gene expression in the meibomian gland. The nature of these alterations, including the upregulation of genes encoding small proline-rich proteins and S100 calcium-binding proteins, suggest that keratinization plays an important role in the pathogenesis of MGD.
Collapse
Affiliation(s)
- Shaohui Liu
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| | - Stephen M. Richards
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| | - Kristine Lo
- the Department of Ophthalmology, and
- the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Mark Hatton
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Aaron Fay
- the Department of Ophthalmology, and
- the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - David A. Sullivan
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| |
Collapse
|
27
|
Butovich IA. Lipidomics of human Meibomian gland secretions: Chemistry, biophysics, and physiological role of Meibomian lipids. Prog Lipid Res 2011; 50:278-301. [PMID: 21458488 DOI: 10.1016/j.plipres.2011.03.003] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 03/11/2011] [Accepted: 03/15/2011] [Indexed: 11/16/2022]
Abstract
Human Meibomian gland secretions (MGS) are a complex mixture of diverse lipids that are produced by Meibomian glands that are located in the upper and the lower eyelids. During blinking, MGS are excreted onto the ocular surface, spread and mix with aqueous tears that are produced by lachrymal glands, and form an outermost part of an ocular structure called "the tear film" (TF). The main physiological role of TF is to protect delicate ocular structures (such as cornea and conjunctiva) from desiccating. Lipids that are produced by Meibomian glands are believed to "seal" the aqueous portion of TF by creating a hydrophobic barrier and, thus, retard evaporation of water from the ocular surface, which enhances the protective properties of TF. As lipids of MGS are interacting with underlying aqueous sublayer of TF, the chemical composition of MGS is critical for maintaining the overall stability of TF. There is a consensus that a small, but important part of Meibomian lipids, namely polar, or amphiphilic lipids, is of especial importance as it forms an intermediate layer between the aqueous layer of TF and its upper (and much thicker) lipid layer formed mostly of very nonpolar lipids, such as wax esters and cholesteryl esters. The purpose of this review is to summarize the current knowledge on the lipidomics of human MGS, including the discussions of the most effective modern analytical techniques, chemical composition of MGS, biophysical properties of Meibomian lipid films, and their relevance for the physiology of TF. Previously published results obtained in numerous laboratories, as well as novel data generated in the author's laboratory, are discussed. It is concluded that despite a substantial progress in the area of Meibomian glands lipidomics, there are large areas of uncertainty that need to be addressed in future experiments.
Collapse
Affiliation(s)
- Igor A Butovich
- Department of Ophthalmology and the Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9057, USA.
| |
Collapse
|
28
|
Knop E, Knop N, Millar T, Obata H, Sullivan DA. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci 2011; 52:1938-78. [PMID: 21450915 PMCID: PMC3072159 DOI: 10.1167/iovs.10-6997c] [Citation(s) in RCA: 687] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/23/2011] [Indexed: 12/15/2022] Open
Affiliation(s)
- Erich Knop
- Ocular Surface Center Berlin, Department for Cell and Neurobiology, Center for Anatomy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | |
Collapse
|